Grassroots health care coverage: local communities are trying novel approaches to providing care for the indigent and working uninsured.

AuthorGordon, Dianna

The statistics are grim when it comes to health care in one of the wealthiest nations in the world:

* There are 44 million Americans without health insurance.

* The United States loses between $65 billion and $310 billion annually because of poor health and early death due to the lack of insurance, according to the Institute of Medicine of the National Academies. The institute report measured "hidden" costs of being uninsured.

* A total of 25 million workers, 18 percent of the workforce, are uninsured.

* The uninsured are more likely to be hospitalized with serious conditions, such as pneumonia and diabetes, that could have been avoided with preventive medical care.

* State health care costs grew 11 percent last year and are projected to grow 13 percent this fiscal year (2003-2004).

* As budgets lie awash in red ink, Medicaid amounted to more than 20 percent of total state spending.

But the glimmer through the fog of spiraling costs and depleted revenues might be found in the smallest microcosm of government--local communities. They are trying novel approaches to providing necessary medical care for the indigent, as well as offering hope to small-business owners and their employees, the working uninsured. From California to Florida, these programs are making a difference.

TURNING STATISTICS AROUND

Muskegon County, Mich., shows how the dismal statistics can be turned around.

Under the county's Access Health program:

* Every $1 of public money leverages $2 of private funds.

* The program generates $2 million annually in new revenue to pay for local health services for previously uninsured people.

* More than 300 businesses are enrolled with 1,400 people served.

* Ninety-seven percent of local providers (more than 200 physicians) participate, as well as both county hospitals.

"The secret is to empower people," says Vondie Woodbury, Muskegon Community Health Project director. "The state allows the community to wrap its arms and minds around these problems and solve them."

Created in 1999, the program was initially designed to help small- and mid-size businesses provide employee health care. The $2 million annual budget is financed through a three-way split. Employers and employees each contribute 30 percent ($42 per month per member) with a community match of 40 percent. The community match comes from federal disproportionate share hospital (DSH) money and state, local and private funding. DSH is essentially federal Medicaid money that states allocate to hospitals that treat a large share of the indigent or uninsured.

Full- and part-time workers who make $10 an hour or less and have no health insurance are eligible. About 1,400 people are enrolled (70 percent are working women between the ages of 18 and 40).

"We've provided for local businesses and for people who don't have health care--the waitress, the child care worker," notes Michigan Representative Julie Dennis. "This has helped stabilize the workforce." And is, in...

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